what is polst? · california polst education program © march 2012 coalition for compassionate care...

What is

POLST? Physician

Orders for

Life

Sustaining

Treatment

California POLST Education Program © March 2012 Coalition for Compassionate Care of California

Materials made possible by a grant from the California HealthCare Foundation 2

Why POLST?

1. Patient wishes often are not known.

– The Advance Healthcare Directive

(AHCD) may not be accessible.

– Wishes may not be clearly defined in

AHCD.

2. Allows healthcare providers to know and

honor wishes during serious illness.



What is POLST?

A physician order recognized throughout

the medical system.

Portable document that transfers with the

patient.

Brightly colored, standardized form for

entire state of CA.



What is POLST?

Allows individuals to choose medical

treatments they want to receive, and

identify those they do not want.

Provides direction for healthcare providers

during serious illness.



Who Would Benefit from Having a

POLST Form?

Chronic, progressive illness

Serious health condition

Medically frail

Tool for determination

– “You wouldn’t be surprised if this patient

died within the next year.”



POLST History

POLST development began in Oregon

in 1991.

Expanded to more than half of US

states.



POLST Success

Oregon study of 180 Skilled Nursing Facility

(SNF) patients:

– POLST stated No CPR and Comfort

Measures Only.

– Patient wishes were honored.

More research available at www.polst.org.



POLST in California

The Coalition for Compassionate Care of

California (CCCC) is lead agency.

Support from California HealthCare

Foundation.

Grassroots efforts of local POLST

coalitions and communities.



POLST in California

Effective January 1, 2009



POLST in California

One form for entire state.

Use not mandated.

Honoring form is mandated.

Provides immunity from civil or criminal

liability.



POLST vs.

Advance Healthcare Directive

POLST complements the Advance

Healthcare Directive (AHCD).

Both are legal documents.



POLST vs.

Advance Healthcare Directive

POLST AHCD

For seriously ill/frail,

at any age

For anyone 18 and

older

Specific orders for

current treatment

General instructions

for future treatment

Can be signed by

decisionmaker

Appoints

decisionmaker



Where Does POLST Fit In?

Advance Care Planning Continuum

Complete an Advance Directive

Complete a POLST Form

Age 18

Treatment Wishes Honored

Diagnosed with Serious or Chronic,

Progressive Illness (at any age)

Update Advance Directive Periodically



POLST vs. Pre-Hospital DNR

(Do Not Resuscitate)

Similarities:

– Physician orders.

– Address Do Not Resuscitate.

– Intended for medically frail or those with

chronic or serious illness.



POLST vs. Pre-Hospital DNR

(Do Not Resuscitate)

POLST Pre-Hospital DNR

Allows for choosing

resuscitation

Can only use if

choosing DNR

Allows for other

medical treatments

Only applies to

resuscitation

Honored across all

healthcare settings

Only honored outside

the hospital



POLST vs. PIC

(Preferred Intensity of Care)

POLST PIC

Consistent form for

CA

PIC form is different

in every SNF

Is a medical order Is not a medical

order; similar to a

doctor’s note

Honored across all

healthcare settings

Only honored within

the SNF



POLST vs. PIC

(Preferred Intensity of Care)

Both include choices for medical

interventions.

POLST can replace the PIC form at SNF.



CA POLST Form – Front Side



Section A: CPR



Section B: Medical Interventions



Diagram of POLST Medical Interventions

CPR

Full Treatment*

DNR

Comfort Measures

Limited Interventions

*Consider time/prognosis factors under “Full Treatment” “Defined trial period. Do not keep on prolonged life support.”



Section C:

Artificially Administered Nutrition



The POLST Conversation

POLST is not just a check-box form.

The POLST conversation provides context

for patients/families to:

– Make informed choices.

– Identify goals of treatment.



Section D: Information and Signatures



Who Can Speak for the Patient?

Surrogate decisionmaker/agent

Parent, guardian, conservator

Closest available relative



CA POLST Form – Back Side



Who Can Help Complete POLST?

Healthcare providers – “licensed, certified, or otherwise authorized to provide healthcare in the normal course of business.”

Best practice suggests use of those trained in the POLST Conversation:

– Physicians

– Nurses

– Social Workers

– Chaplains

– Social Service Designees



Directions – Completing POLST



Directions – Using POLST



Directions –

Reviewing/Modifying/Voiding POLST



When Should POLST be Reviewed?

Transfer from one care setting to another.

Change in patient’s health condition.

Patient’s treatment preferences change.

Patient Care Conference.



Can POLST be Changed?

Individual with capacity can request

alternative treatment or revoke a POLST

at anytime.

Legally recognized decisionmaker may

request change based on condition

change or new information regarding

patient wishes.



Original pink POLST stays with patient

At SNF/Hospital:

– File in medical chart (with AHCD).

– Send original with patient upon return to

home/SNF/hospital.

– Keep copy if resident transferred; review

POLST upon resident’s return.

Where Should We Keep POLST?



At home:

– Post in easy-to-find location (with AHCD).

– Give to EMS to transport with patient.

Where Should We Keep POLST?



POLST: Depth of the Process

POLST is more than a form.

POLST:

– Facilitates rich conversations with

patients/families.

– Complements the AHCD.

– Incorporates the depth of comfort care.



California POLST Project

C oalition for

The Coalition for Compassionate Care of California (CCCC) provides

leadership and oversight for POLST outreach activities in California, with

support from the California HealthCare Foundation.

C ompassionate

C are of

C alifornia



POLST Conversation

A rich conversation with

each individual patient

Comprehensive Education

To promote excellent conversational

skills with patients and families

Consistent Form

Standardized form recognized

across care settings

Translating an individual’s wishes for care during serious or chronic illness

into medical orders that honor those preferences for medical treatment.

Community Collaboration

Integrating POLST into the

community standard of care

California POLST Project



California POLST Form

Available at www.caPOLST.org

– Translations available

May be purchased from:

– www.med-pass.com

(bulk forms/paper)

– www.cmanet.org

(POLST Kit)

©California Medical Association 2009



California POLST Form

Print on Ultra Pink, 65# card stock paper

Copies/faxes on any color paper are

acceptable

Focus on the conversation



POLST Resources

Provider and Consumer Brochures

Decision-Making Guides

FAQs

Videos



POLST Resources

Model policies and procedures

Standardized educational curriculum

Local POLST coalitions

www.caPOLST.org

Questions?

what is polst? · california polst education program © march 2012 coalition for compassionate care...

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